Comedocarcinomas
Comedocarcinoma, also referred to as high-grade ductal carcinoma in situ (DCIS), is a specific type of very early-stage breast cancer that often goes undetected for years. This subtype accounts for approximately 40% of all DCIS cases and is characterized by the presence of necrotic material within the breast ducts. Most cases occur after the age of fifty, and patients are typically asymptomatic, with detection primarily through mammography, which reveals distinctive microcalcifications in a linear or branching pattern.
Risk factors for developing comedocarcinoma include older age, having fewer children, obesity, and a family history of breast cancer. While DCIS is classified as Stage 0 cancer and is considered non-invasive, the comedocarcinoma type carries a higher risk of progression to invasive cancer compared to noncomedo types. Standard treatment usually involves surgical options such as needle localization and lumpectomy, often followed by radiation, or mastectomy in more severe cases. If left untreated, studies suggest that a significant percentage of women with comedocarcinoma may develop invasive cancer within five to ten years. Understanding this condition is essential for early intervention and effective management.
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Subject Terms
Comedocarcinomas
ALSO KNOWN AS: Ductal carcinoma in situ (DCIS), high nuclear grade or poorly differentiated DCIS
RELATED CONDITIONS: Spontaneous nipple discharge, Paget disease
DEFINITION: Comedocarcinoma is a type of ductal carcinoma in situ (very early-stage breast cancer), which accounts for up to half of all breast cancers diagnosed with mammography. Most cases appear after age fifty and may persist for years without a palpable abnormality. Ductal carcinoma in situ (DCIS) is a family of cancers in the breast ducts. There are two categories of DCIS—noncomedo and comedo. The high-grade or comedo type represents 40 percent of all DCIS and, on pathologic evaluation, appears as plug-like necrotic material that can be expressed from the ducts of the cut pathology specimen. On mammography, a linear branching or casting pattern of microcalcifications is often visible.
Risk factors: Risk factors include increasing age, having few children and the first child after the age of thirty, obesity, a history of atypical hyperplasia or breast carcinoma, and having a mother or sibling with breast cancer.
Etiology and the disease process: In comedocarcinoma, cancer forms in the breast ducts. The comedo form of DCIS has dead cells (necrosis) that plug the center of the breast duct. It tends to grow fast and has a higher risk of invasive cancer than noncomedo DCIS.
Incidence: Ductal carcinoma in situ is becoming increasingly common, accounting for 22 to 45 percent of newly diagnosed cases of breast cancer. The comedo type represents about 40 percent of the cases and carries a poorer prognosis.
Symptoms: Most patients are asymptomatic. Less commonly, DCIS appears as a mass with ill-defined or lobulated borders on a mammogram, which may or may not be associated with microcalcifications.
Screening and diagnosis: On a mammogram, comedo carcinoma manifests as clusters of pleomorphic (many-formed), ductally oriented microcalcifications. In the staging system used to classify cancer, DCIS is known as Stage 0 and is sometimes called precancer. It is also called tumor in situ (Tis), meaning the cancer is noninvasive.
Treatment and therapy: The standard treatment is needle localization and lumpectomy with radiation or simple or modified mastectomy.
Prognosis, prevention, and outcomes: Some 20 to 50 percent of women with comedocarcinoma develop invasive cancer five to ten years after initial diagnosis if the cancer is not removed surgically. Studies suggest that about a third or more of DCIS patients will develop invasive cancer if their DCIS is left untreated.
Bibliography
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